Centers for Medicare and Medicaid Services (CMS) Clarifies Proper Use of Modifier -59
In revised MLN Matters® Article SE 1418, CMS clarifies the proper use of modifiers -59 and -XE, -XP, -XS, -XU in the existing policy. This information is for physicians and providers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.
The revision specifically includes the addition of modifiers -XE, -XP, -XS, -XU in the policy. These modifiers were developed to provide greater specificity in situations where modifier -59 was previously reported, and are used in direct relation to the National Correct Coding Initiative (NCCI) just like modifier -59. They should be reported instead of modifier -59 when possible. Modifier -59 is referred to as the modifier of last resort, meaning this modifier should only be used if no other, more specific modifier is appropriate:
- XE – Separate encounter: a service that is distinct because it occurred during a separate encounter. This modifier should only be used to describe separate encounters on the same date of service.
- XS – Separate Structure: a service that is distinct because it was performed on a separate organ/structure.
- XP – Separate Practitioner: a service that is distinct because it was performed by a different practitioner
- XU – Unusual Non-Overlapping Service: the use of a service that is distinct because it does not overlap usual components of the main service.
The policy explains the function of the NCCI edits; defines each of the above mentioned modifiers; describes the proper usage of these modifiers; and provides coding examples. To read the article in its entirety, click on the link:
